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SOEPEL – 5 GASTRO-OESOPHAGEAL REFLUX DISSESE AHMAD MHD ALDHLAWIY 1

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Post on 27-Nov-2014

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  • 1. AHMAD MHD ALDHLAWIY1

2. DEFINITIONMANEGEMENTLOCATIONSOEPELCLINICAL FEATURESINVESTIGATIONCAUSES2 3. Subject:A 35 year old patient admitted to the hospital cause of excessive vomiting. History: the patient complain with abdominal pain, excessive vomiting, and loss of weight.3 4. Pain analysis: 1.Site: epigastric.2.Onset: episodic.3.Character: burning.4.Associated factors: --5.Time/duration: 4 months.6.Exaggerated factors: after eating.7.relieving factors: medication.8.Severity: moderate 4 5. Object: General examination & Abdominal examination. Evaluation (DD): achalasia, hiatal hernia. Plan: Endoscopy. Elaboration: change lifestyle. Learning goals: GERD.5 6. highly variable chronic condition that is characterized by periodic episodes of gastroesophageal reflux usually accompanied by heartburn and that may result in histopathologic changes in the esophagus.6 7. 7 8. HEART BURN: It is a major feuters, aggrevated bybending, stopping or laying down which promote acid exposure. The complain of pain well be during drinking hot liquid or alcohol. REGURGITATION: Food and acid into the mouthoccurs particular on bending or layig flat.8 9. Obesity. Pregnancy. Certain medications, such as asthma medications,calcium channel blockers, and many antihistamines, pain killers, sedatives, and antidepressants. Smoking, or inhaling secondhand smoke.9 10. Assess oesophagitis and hiatal hernia by endoscopy: If there is oesophagitis or Barretts oesophagus, reflux is confirmed. Document reflux by intraluminal monitoring: 24-hour intraluminal pH monitoring or impedance combined with manometry is helpful if there is no response to PPI and should always be performed to confirm reflux before surgery.10 11. 11 12. Change Lifestyle: losing weight, if needed wearing loose-fitting clothing around the stomach area. remaining upright for 3 hours after meals. raising the head of the bed 6 to 8 inches by securing wood blocksunder the bedpostsjust using extra pillows will not help.12 13. Medication: Alginate-containing antacids: (10 mL three times daily), if it contain magnesium antacid it will cause to diarrehea, or if it contain aluminum it will cause to concitipation. The dopamine antagonist prokinetic agents : they enhance peristalsis and speed gastric emptying. H2-receptor antagonists: used for acid suppression if antacids fail as they can often be obtained over the counter. Proton pump inhibitors: inhibit gastric hydrogen/potassium-ATPase. PPIs reduce gastric acid secretion by up to 90% and are the drugs of choice for allbut mild cases.13 14. Surgery: Fundoplication. Endoscopic techniques.14 15. Kumar and clarks 8th edition. Oxforf clinical medicine.15